In Myanmar, a global health threat breeds room for new cooperation

Earlier this year troubling news emerged about a mounting threat to global malaria control and eradication efforts: resistance to front-line malaria drugs threatens to cross the mountainous border between Myanmar and India. If that happens, some speculate drug-resistant malaria could infiltrate the African continent and put millions of lives in jeopardy. There is a more hopeful side to this story. In Myanmar, a country rife with political conflict, torn by ethnic division and long-isolated from international cooperation, some hope controlling resistance and ultimately eradicating malaria could be the cause that catalyzes a new spirit of cooperation between the government and marginalized ethnic groups, between the military and civil society, and across political divides. That was the idea behind this week’s dialogue convened in Washington, D.C., by the Institute for Global Health at the University of Maryland School of Medicine, the American Society of Tropical Medicine and Hygiene and the Center for Strategic and International Studies. The “unprecedented” meeting convened representatives of a wide array of Myanmarese constituencies, including military officers, health officials, opposition leaders and representatives from nongovernmental organizations, to discuss how action against malaria might proceed regardless of political circumstances in the country. “Malaria is something that everybody shares. From suffering, everybody understands that this impedes any type of growth,” Myaing Nyunt, director of the IGH efforts in Myanmar, told Devex at a news conference following the dialogue. In a way, the fearful specter of resistance to artemisinin, a must-have drug in the battle against one of the world’s deadliest diseases, rising in remote and rugged northern Myanmar, has made clear that global health cooperation has to move faster than political consensus. “Once artemisinin resistance came on the scene … it just became so clear that if we don’t work with the military … if we wait for cease-fires to be signed before we do this, it’s going to be too late,” IGH Director Chris Plowe told Devex. “Resistance will be in Africa, and that will be catastrophic.” Myanmar’s citizens will go to the polls Nov. 8 in a critical general election many fear will not reflect as well as might be hoped on the country’s progress toward democratic reform. And those concerns are precisely why advocates of malaria as a catalyst for social change — and the participants and organizers of this week’s conference — hope it will build a foundation for cooperation that can weather political turmoil. Senior health adviser to Aung San Suu Kyi and member of the National League for Democracy, an opposition party that will contest the elections, Tin Myo Win lent some credence to that sense of optimism. “This morning we noted that whoever won the coming election, this group … would go on because there would be still this disease in our country,” he told reporters. “By bringing all these diverse groups here, facing each other, discussing, debating, we have a very optimistic view that we can overcome all these diverse challenges.” That comes as welcome news to malaria experts who worry that a messy election could prompt cuts in U.S. foreign assistance to the country. That was one of the reasons for holding the cooperative discussions in Washington, instead of in Yangon or Naypyitaw — to send a message to America that Myanmar is ready to put aside political rivalries and keep its eye on the malaria fight, Nyunt told Devex. “We don’t want malaria to be subject to rising and falling political interests,” Plowe said. “It’s in everybody’s interest, including very much in the U.S. interest, to prevent artemisinin resistance from getting to India and Africa and beyond.” Plowe cautioned that even if November’s election does not proceed as hoped, and if political infighting or corruption concerns prompt the U.S. Agency for International Development or others to cut back foreign assistance to the Southeast Asian nation, cuts to malaria programs should not be on the table. “We want commitment on the U.S. side to push forward with malaria elimination no matter what happens here in the [U.S. presidential] election, there in the [Myanmar general] election, cease-fires being signed or not being signed. Malaria elimination should go forward,” he said. According to Myanmar’s Deputy Minister of Health Thein Thein Htay, the country is in the process of transitioning from a malaria control program to a malaria elimination program and, together with development partners, aims to eliminate the disease by 2025. “Malaria elimination is much different from the control program,” the deputy minister said in response to a question from Devex. “We controlled it very well. To eliminate we intend to have a very ambitious … zero transmission [goal] … For the next 15 years we need a lot of resources … To have the success for malaria elimination, we need to ensure the inclusive contribution by all stakeholders.” Nyunt, who was a student activist before leaving Myanmar in the 1980s, told Devex cooperation hasn’t happened in the past because Myanmar’s citizens hesitate to describe problems and national systems don’t respond to them. “The culture and system feeds each other to survive and it’s almost like a viscous circle, and we need to break this circle,” she said. “I think this is a break.” To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.